Introduction: Management of clinical T1 renal masses has become a complex, preference-sensitive decision. In a previous study, 30% of patients with SRMs reported decisional conflict. More patient-centered communication that could reduce decisional conflict, but its determinants remain unknown. Therefore, we sought to evaluate the clinical and decision-making factors impacting patient-centered communication in patients with clinical T1 renal masses. Methods: From October 2018–June 2022, we enrolled patients with new clinical T1 kidney tumors onto GRADE-SRM, a comparative, non-randomized hybrid trial investigating the decision-making experience and cancer genomics. Upon study entry (T0) and 2-4 weeks later (T1), participants completed surveys to characterize their decision-making and communication preferences in addition to demographic, health, and tumor characteristics. Patient-centered communication served as the primary outcome and measured by the validated Patient-Centered Communication in Cancer Care (PCC) Instrument. We examined the relationship between PCC and patient/tumor characteristics through repeated measures bivariable linear regression analyses using generalized estimating equations. Results: Among 265 enrollees, 229 completed a T0 PCC survey and 195 enrollees completed a T1PCC survey. Mean age was 62.3 years (SD 11.2), 61.4% were male, and 31.8% were non-White. Overall, mean PCC score was 4.40 (SD 0.62) at T0 and 4.31 (SD 0.69) at T1. Patients with higher levels of education (p=0.047), previous history of kidney cancer (p=0.0001), and previous abdominal surgery (p=0.011) reported better communication scores. Worse communication scores were associated with seeing an outside urologist prior to UNC evaluation (p=0.022) and higher perceived risk of metastasis (p=0.015). Better communication scores were associated with higher self-efficacy (p=0.003), numeracy (p=0.019) and information seeking behavior (p=0.011), while worse communication scores were associated with increased worry (p=0.021). Conclusions: For patients with SRMs, more patient-centered communication is reported by those with similar past healthcare experiences, more self-efficacy, and information seeking behavior. These findings highlight the importance of both lived experiences and patient learning ability on their perception of communication. Efforts to improve communication and decision-making may need to be directed toward these action points. SOURCE OF Funding: This work was supported by funding from the National Institutes of Health (UNC Integrated Translational Oncology Program T32-CA244125 to UNC/khg) and UNC Lineberger Comprehensive Cancer Center UNCseq v2.
